Hollow tissue inosculation apparatus

ABSTRACT

A hollow tissue inosculation apparatus is to inosculate two hollow tissues to each other with a staple having a plurality of elastically deformable bent staple pins. The hollow tissue inosculation apparatus includes a staple holder to hold the staple, a curvature control mechanism to control curvature of the staple pins of the staple held in the staple holder, and a gap control mechanism to control gaps of the hollow tissues with respect to the staple holder. The curvature control mechanism substantially straightens the staple pins. The gap control mechanism reduces the gaps to cause the substantially straightened staple pins to penetrate the hollow tissues. The curvature control mechanism and the gap control mechanism are independent from each other.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is based upon and claims the benefit of priority fromprior Japanese Patent Application No. 2008-161927, filed Jun. 20, 2008,the entire contents of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a hollow tissue inosculation apparatusto inosculate two hollow tissues to each other.

2. Description of the Related Art

A hollow tissue inosculation apparatus includes an anastomotic apparatusto anastomose blood vessels as hollow tissues in, e.g., coronary-arterybypass surgery. For example, a specification of U.S. Patent ApplicationLaid-open No. 2006/0069401 discloses such an apparatus. This apparatususes a staple, which is made of an elastic spring material havingshape-memory characteristics and is formed to be automatically restoredto a substantial arched or hook-like conformation when a holding forceof substantially straightening staple pins is eliminated. On the otherhand, a member to substantially straighten staple pins also has afunction of controlling a gap between blood vessels, and the staple pinsare restored to an arched shape or a hook-like shape as the gap betweenthe blood vessels is reduced. Based on this configuration, non-suturedconnection is achieved.

BRIEF SUMMARY OF THE INVENTION

The present invention is directed to a hollow tissue inosculationapparatus to inosculate two hollow tissues to each other with a staplehaving a plurality of elastically deformable bent staple pins. Thehollow tissue inosculation apparatus includes a staple holder to holdthe staple, a curvature control mechanism to control curvature of thestaple pins of the staple held in the staple holder, and a gap controlmechanism to control gaps of the hollow tissues with respect to thestaple holder. The curvature control mechanism substantially straightensthe staple pins. The gap control mechanism reduces the gaps to cause thesubstantially straightened staple pins to penetrate the hollow tissues.The curvature control mechanism and the gap control mechanism areindependent from each other.

Advantages of the invention will be set forth in the description whichfollows, and in part will be obvious from the description, or may belearned by practice of the invention. Advantages of the invention may berealized and obtained by means of the instrumentalities and combinationsparticularly pointed out hereinafter.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention, andtogether with the general description given above and the detaileddescription of the embodiments given below, serve to explain theprinciples of the invention.

FIG. 1 shows a staple in a natural state according to an embodiment ofthe present invention;

FIG. 2 shows the staple when inserted into a hollow tissue inosculationapparatus according to an embodiment of the present invention;

FIG. 3 shows an appearance of the hollow tissue inosculation apparatusaccording to an embodiment of the present invention;

FIG. 4 shows an inner mechanism of a treatment unit depicted in FIG. 3;

FIG. 5 shows the inner mechanism of the treatment unit with an outerslider removed from the state depicted in FIG. 4;

FIG. 6 shows the inner mechanism of the treatment unit with an innerslider removed from the state depicted in FIG. 5;

FIG. 7 is an exploded perspective view of an incision mechanism built inthe treatment unit depicted in FIG. 3;

FIG. 8 is an assembly completion diagram of the incision mechanismdepicted in FIG. 7;

FIG. 9 is a perspective view showing an opened graft support mechanismas viewed from an obliquely upper position;

FIG. 10 is a perspective view showing the graft support mechanismdepicted in FIG. 9 as viewed from an obliquely lower position;

FIG. 11 is a perspective view showing the graft support mechanism thatis unlocked when a pin is retracted into a base portion from a statedepicted in FIG. 10 as viewed from an obliquely lower position;

FIG. 12 is a perspective view showing the graft support mechanism in astate where a fixing portion linearly extends with respect to the baseportion as viewed from an obliquely upper position;

FIG. 13 is a perspective view showing the closed graft support mechanismas viewed from an obliquely lower position;

FIG. 14 schematically shows a graft holding mechanism provided to thegraft support mechanism;

FIG. 15 shows the staple in the natural state and the treatment unit ofthe hollow tissue inosculation apparatus;

FIG. 16 is a perspective view of the treatment unit of the hollow tissueinosculation apparatus into which the staple is inserted;

FIG. 17 is a side view of the treatment unit depicted in FIG. 16;

FIG. 18 is a perspective view of the treatment unit in whichcoronary-artery supports are inserted in a coronary artery and graftsupports are inserted in a graft;

FIG. 19 is a side view of the treatment unit depicted in FIG. 18;

FIG. 20 is a perspective view of the treatment nit in which the graftsupport mechanism is closed;

FIG. 21 is a side view of the treatment unit depicted in FIG. 20;

FIG. 22 is a front view of the treatment unit depicted in FIG. 20;

FIG. 23 is a perspective view of the treatment unit in which endportions of the staple pins are stuck in the graft and the coronaryartery;

FIG. 24 is a side view of the treatment unit depicted in FIG. 23;

FIG. 25 is a front view of the treatment unit depicted in FIG. 23;

FIG. 26 is a perspective view of the treatment unit in which blades ofcutters are arranged between the graft and the coronary artery;

FIG. 27 is a side view of the treatment unit depicted in FIG. 26;

FIG. 28 is a front view of the treatment unit depicted in FIG. 26;

FIG. 29 is a perspective view of the treatment unit in which incision ofthe graft and the coronary artery is finished;

FIG. 30 is a side view of the treatment unit depicted in FIG. 29;

FIG. 31 is a front view of the treatment unit depicted in FIG. 29;

FIG. 32 is a perspective view of the treatment unit while the cuttersare retracted into a housing;

FIG. 33 is a side view of the treatment unit depicted in FIG. 32;

FIG. 34 is a front view of the treatment unit depicted in FIG. 32;

FIG. 35 is a perspective view of the treatment unit in which staple pinsfurther are stuck into the graft and the coronary artery;

FIG. 36 is a side view of the treatment unit depicted in FIG. 35;

FIG. 37 is a front view of the treatment unit depicted in FIG. 35;

FIG. 38 is a perspective view of the treatment unit in which the endportions of the staple pins have penetrated through the graft and thecoronary artery;

FIG. 39 is a side view of the treatment unit depicted in FIG. 38;

FIG. 40 is a front view of the treatment unit depicted in FIG. 38;

FIG. 41 is a perspective view of the treatment unit in which the graftsupports and the coronary-artery supports have been moved away from astaple holder;

FIG. 42 is a side view of the treatment unit depicted in FIG. 41;

FIG. 43 is a front view of the treatment unit depicted in FIG. 41;

FIG. 44 is a perspective view of the treatment unit in which pillarshave been moved closer to the staple holder;

FIG. 45 is a side view of the treatment unit depicted in FIG. 44;

FIG. 46 is a front view of the treatment unit depicted in FIG. 44;

FIG. 47 is a perspective view of the treatment unit that is beingremoved from the graft and the coronary artery;

FIG. 48 is a side view of the treatment unit depicted in FIG. 47;

FIG. 49 is a perspective view of the graft and the coronary artery thatare inosculated to each other;

FIG. 50 is a perspective view showing the partially cutaway graftdepicted in FIG. 49;

FIG. 51 is a cross-sectional view of the graft and the coronary arterythat are inosculated to each other and shown in FIG. 49; and

FIG. 52 shows another staple that can be used in place of the stapledepicted in FIGS. 1 and 2.

DETAILED DESCRIPTION OF THE INVENTION

An embodiment according to the present invention will now be describedhereinafter with reference to the accompanying drawings.

This embodiment concerns a staple and a hollow tissue inosculationapparatus to inosculate two hollow tissues to each other. The hollowtissues are specifically blood vessels.

The staple as a fastening to inosculate two hollow tissues will be firstdescribed with reference to FIGS. 1 and 2. Each of FIGS. 1 and 2 is aperspective view of the staple according to this embodiment. FIG. 1shows the staple in a natural state, and FIG. 2 shows the stapleinserted into the hollow tissue inosculation apparatus.

As shown in FIGS. 1 and 2, the staple 10 has an elastically deformablering-like ring member 12 and a plurality of elastically deformable bentstaple pins 14. Each staple pin 14 is fixed on the inner side of thering member 12. An axis of the ring member 12 is on a plane, an axis ofeach staple pin 14 is on a different plane, and these planes aresubstantially orthogonal to each other. Here, an axis of a member meansa line extending along this member. For example, an axis of the memberis a line running through the center of a cross section obtained bycutting away each portion of this member based on a plane runningthrough its center of curvature.

The ring member 12 has a shape expanded toward the outside in a naturalstate. The ring member 12 has a closed ring shape.

Part of each staple pin 14 close to a position fixed to the ring member12 is bent toward the outside of the ring member 12, and the otherparts, which are closer to ends than that part, are bent in a C-likeshape toward the inside of the ring member 12. Both ends of each staplepin 14 face each other in the natural state. These staple pins 14 arearranged so as not to come into contact with each other. For example,the same number of staple pins 14 are arranged on two sides, the staplepins on both sides are arranged at the same fixed pitch, and the staplepins 14 on one side deviate from the staple pins 14 on the other side ata half pitch.

Although the ring member 12 is, herein, formed of a wire rod, thepresent invention is not restricted thereto, and the ring member 12 maybe formed of a plate material or a molding material. Although eachstaple pin 14 is also, herein, formed of a wire rod, the presentinvention is not restricted thereto, and each staple pin 14 may beformed of a plate material or a molding material. The ring member 12 andthe staple pins 14 are formed by, e.g., bonding different members, butthe present invention is not restricted thereto, and they may beintegrally formed. Although the staple 10 has the eight staple pins 14here, the number of the staple pins 14 is not restricted thereto, and itmay be freely changed. Further, a gap, a relative position, or arelative direction of the staple pins 14 can be also freely changed.

For example, the ring member 12 is formed of a hyperelastic material,and the staple pins 14 are also formed of a hyperelastic material. Here,the “hyperelastic material” means a material that shows a hyperelasticeffect.

The “hyperelastic effect” means that strain is immediately eliminated torestore the member to its original shape when stress is removed eventhough deformation strain (approximately 8%) exceeding Hook's law isgiven. In a regular metal material, when deformation strain(approximately 0.5% or above) exceeding an elastic area is given, straincorresponding to elastic deformation alone is eliminated and permanentstrain remains even though stress is removed.

In hyperelasticity generation mechanism, when force is applied in aparent phase, martensite is generated from the parent phase, and eachcrystal sequentially changes its direction, thereby producingmacroscopic deformation of an outer shape. When the force is removed,the parent phase is restored while maintaining connection betweencrystals, and hence the microscopic shape returns to the original state.

Alloy having the hyperelastic effect includes not only a titanium-nickel(Ti—Ni) alloy but also a copper-aluminum-nickel alloy, acopper-zinc-aluminum alloy, and a nickel-aluminum alloy. In recentyears, it further includes an Fe—Al-based alloy that shows greathyperelasticity without changing a martensite conformation.

The ring member 12 and the staple pins 14 are not restricted to thehyperelastic materials, and they may be formed of an arbitrarybiocompatible material having a wide elasticity range including plasticor ceramic.

The hollow tissue inosculation apparatus to inosculate two hollowtissues by using the staple depicted in FIGS. 1 and 2 will now bedescribed with reference to FIGS. 3 to 8. FIG. 3 shows an appearance ofthe hollow tissue inosculation apparatus according to this embodiment.FIGS. 4 to 6 show an inner mechanism of a treatment unit depicted inFIG. 3. FIGS. 7 and 8 show an incision mechanism built in the treatmentunit depicted in FIG. 3.

In the following description, the hollow tissue inosculation apparatusis a so-called anastomosing apparatus used in coronary-artery bypasssurgery, which inosculates a different blood vessel (a graft) to acoronary artery that is narrowed or blocked. That is, one of the twohollow tissues is the coronary artery, and the other is the graft. Thesetissues are reflected in names of respective members.

As shown in FIG. 3, the hollow tissue inosculation apparatus 100 has atreatment unit 102 to inosculate the coronary artery to the graft, anoperation unit 106 to operate the treatment unit 102, and a connectingrod 104 connecting the treatment unit 102 to the operation unit 106. Theoperation unit 106 is provided with operation knobs to operate eachportion in the treatment unit 102.

As shown in FIG. 3, the treatment unit 102 has a staple holder 200 tohold the staple 10, a coronary-artery support mechanism 300 to supportthe coronary artery, and a graft support mechanism 400 to support thegraft.

As shown in FIGS. 4 to 6, the staple holder 200 has two prismatic stapleholding members 210 to hold the staple. The staple holding members 210are arranged at a fixed interval narrower than a width of the ringmember 12 of the staple 10 in the natural state therebetween, and theyextends in parallel in the forward direction from a base member 220.Each staple holding member 210 has a groove 212 to receive the ringmember 12 of the staple on a surface facing a counterpart. The stapleholding members 210 and the base member 220 are integrally formed, forexample.

In the following description, directions perpendicular to a planeincluding a central axis of the two staple holding members 210 will bereferred to as upward-and-downward directions, directions along whichthe two staple holding members 210 extends will be referred to as aforward-and-backward directions, and directions perpendicular to theupward-and-downward directions and the forward-and-backward directionswill be referred to as lateral directions for convenience ofexplanation. Moreover, in regard to the upward-and-downward directions,a direction that the graft support mechanism 400 is placed with respectto the staple holder 200 will be referred to as an upward direction, anda direction that the coronary-artery support mechanism 300 is placedwill be referred to as a downward direction. Additionally, in regard tothe forward-and-backward directions, a direction extending from a fixedend of the staple holding member 210 toward a free end of the same willbe referred to as a forward direction, and its opposite direction willbe referred to as a backward direction.

As shown in FIGS. 4 to 6, the coronary-artery support mechanism 300includes a pair of coronary-artery supports 312 extending in parallel toeach other, a fixing portion 314 to which the coronary-artery supports312 are fixed, and a base portion 316 to which the fixing portion 314 isdisposed. The fixing portion 314 is coupled with the base portion 316through a shaft 318 so as to swivel with respect to the base portion 316on the center of the shaft 318. The base portion 316 is fixed to theframe 110.

As shown in FIGS. 4 to 6, the graft support mechanism 400 includes apair of graft supports 412 extending in parallel to each other, a fixingportion 414 to which the graft supports 412 are fixed, a base portion416 to which the fixing portion 414 is fixed. The fixing portion 414 iscoupled with the base portion 416 through a shaft 418 so as to swivelwith respect to the base portion 416 on the center of the shaft 418.

As shown in FIGS. 4 to 6, the treatment unit 102 also has a pair ofouter pillars 512 extending in parallel to each other and a pair ofinner pillars 532 extending in parallel in order to control curvature ofthe staple pins 14 on the lower side, i.e., the coronary artery side, ofthe staple 10. The outer pillars 512 are coupled with each other, and arelative positional relationship of these pillars is maintainedconstant. The inner pillars 532 are coupled with each other, and arelative positional relationship of these pillars is maintainedconstant. The outer pillars 512 come into contact with the outer side ofthe staple pins 14 of the staple 10 held in the staple holder 200, andthe inner pillars 532 come into contact with the inner side of thestaple pins 14 of the staple 10 held in the staple holder 200.

Likewise, as shown in FIGS. 4 to 6, the treatment unit 102 has a pair ofouter pillars 612 extending in parallel to each other and a pair ofinner pillars 632 extending in parallel to each other in order tocontrol curvature of the staple pins 14 on the upper side, i.e., thegraft side, of the staple 10. The outer pillars 612 are coupled witheach other, and a relative positional relationship of these pillars ismaintained constant. The inner pillars 632 are coupled with each other,and a relative positional relationship of these pillars is maintainedconstant. The outer pillars 612 come into contact with the outer side ofthe staple pins 14 of the staple 10 held in the staple holder 200, andthe inner pillars 632 come into contact with the inner side of thestaple pins 14 of the staple 10 held in the staple holder 200.

The staple holder 200, the graft support mechanism 400, the outerpillars 512, the inner pillars 532, the outer pillars 612, and the innerpillars 632 are allowed to move in the upward-and-downward directions bya groove cam mechanism, which will be explained later. This groove cammechanism is covered with a cover 190 as shown in FIG. 3.

The treatment unit 102 includes an incision mechanism 700 to incise thecoronary artery and the graft.

The incision mechanism 700 includes a cutter 710 to incise the coronaryartery and a cutter 720 to incise the graft as shown in FIGS. 7 and 8.The cutter 710 has a support portion 716 having a long groove 718, anarm 714 extending from the support portion 716, and a blade 712 providedat an end portion of the arm 714. The cutter 720 has substantially thesame structure as the cutter 710, and has a support portion 726 having along groove 728, an arm 724 extending from the support portion 726, anda blade 722 provided at an end portion of the arm 724 like the cutter710.

The incision mechanism 700 has a support member 730 to support thecutters 710 and 720, a support member 750 to support the support member730, and a guide 770 to support the support member 750.

The support member 730 has a plate-like member 732 bent into an invertedU shape and a columnar pin 734 fixed to the plate-like member 732. Theplate-like member 732 has, on each of lateral both sides, a groove 736positioned at a central portion, grooves 742 and 744 positioned belowthe groove 736, and grooves 746 and 748 positioned above the groove 736.The groove 736 linearly extends in the forward-and-backward directions.The grooves 742 and 744 obliquely linearly extend with respect to theforward-and-backward directions, and a front end portion of each of thegrooves 742 and 744 is positioned below a rear end portion of the same.The grooves 746 and 748 obliquely linearly extend with respect to theforward-and-backward directions, and a front end portion of each of thegroove 746 and 748 is positioned above a rear end portion of the same.The pin 734 extends in the upward-and-downward directions.

The support member 750 is formed of a bent plate-like member, and hastwo plate-like portions 752 parallel to each other and a bent portion754 extending to be bent in a C-like shape between the two plate-likeportions 752. Each of the plate-like portions 752 has a groove 762positioned on the front side, a groove 764 positioned on the rear side,a hole 766 at the back of the groove 762, and a hole 768 in front of thegroove 764. The grooves 762 and 764 extend in the upward-and-downwarddirections in parallel to each other. The holes 766 and 768 arepositioned near the center in relation to the upward-and-downwarddirections. The bent portion 754 has a groove 756 into which the pin 734of the support member 730 is inserted on the upper side thereof. Thegroove 756 extends in the forward-and-backward directions.

The guide 770 includes two rails 776 running on the inside of the bentportion 754 of the support member 750, a front fixing portion 772 towhich front end portions of the rails 776 are fixed, and a rear fixingportion 774 to which rear end portions of the rails 776 are fixed. Therails 776 support the support member 750 to be movable in theforward-and-backward directions. The front fixing portion 772 has a pairof pins 782 protruding laterally. The rear fixing portion 774 has a pairof pins 784 protruding laterally.

The support member 730 is arranged so that the pin 734 is inserted inthe groove 756 of the support member 750, the plate-like member 732 isplaced between the plate-like portions 752 of the support member 750,and the grooves 736 are aligned with the holes 766 and 768 of thesupport member 750, and a pin 802 is inserted into the holes 766 of thesupport member 750 and the grooves 736 of the support member 730.Further, a pin 804 is inserted into the holes 768 of the support member750 and the grooves 736 of the support member 730. The support member730 is supported to be movable in the forward-and-backward directionswith respect to the support member 750 by such a groove mechanism.

The cutter 720 is arranged so that the support portion 726 is placedinside the plate-like member 732 of the support member 730, the longgroove 728 is aligned with an overlapping portion of the grooves 746 ofthe support member 730 and the grooves 762 of the support member 750 andalso aligned with an overlapping portion of the grooves 748 of thesupport member 730 and the grooves 764 of the support member 750.Furthermore, a pin 796 is inserted into the grooves 762 of the supportmember 750, the grooves 746 of the support member 730, and the longgroove 728 of the cutter 720, and a pin 798 is inserted into the grooves764 of the support member 750, the grooves 748 of the support member730, and the long groove 728 of the cutter 720. The cutter 720 issupported to be movable in the upward-and-downward directions withrespect to the support member 750 and movable in theforward-and-backward directions with respect to the support member 730by such a groove cam mechanism.

The cutter 710 is arranged so that the support portion 716 is placedinside the plate-like member 732 of the support member 730 and the longgroove 718 is aligned with an overlapping portion of the grooves 742 ofthe support member 730 and the grooves 762 of the support member 750 andalso aligned with an overlapping portion of the grooves 744 of thesupport member 730 and the grooves 764 of the support member 750.Furthermore, a pin 792 is inserted into the grooves 762 of the supportmember 750, the grooves 742 of the support member 730, and the longgroove 718 of the cutter 710, and a pin 794 is inserted into the grooves764 of the support member 750, the grooves 744 of the support member730, and the long groove 718 of the cutter 710. The cutter 710 issupported to be movable in the upward-and-downward directions withrespect to the support member 750 and also movable in theforward-and-backward directions with respect to the support member 730by such a groove cam mechanism.

In the thus configured incision mechanism 700, the cutter 710 and thecutter 720 move in the forward-and-backward directions for movement ofthe support member 750 in the forward-and-backward directions withrespect to the guide 770. Furthermore, the cutter 710 moves in thedownward direction and the cutter 720 moves in the upward direction formovement of the support member 730 in the backward direction withrespect to the support member 750. Contrarily, the cutter 710 moves upand the cutter 720 moves down for movement of the support member 730 inthe forward direction with respect to the support member 750.

As shown in FIG. 8, wire assemblies 810, 820, 830, 840, 850, 860, 870,and 880 to operate the incision mechanism 700 are disposed to theincision mechanism 700.

The wire assemblies 810 and 820 are to move the support member 750 inthe forward-and-backward directions with respect to the guide 770. Thewire assembly 810 includes a wire 812 fixed to the support member 750and a wire outer tube 814 fixed to a rear fixing portion 774 of theguide 770. Moreover, the wire assembly 820 includes a wire 822 fixed tothe support member 750 and a wire outer tube 824 fixed to a front fixingportion 772 of the guide 770. The wire assemblies 810 and 820 extend tothe operation unit 106 through the connecting rod 104, and the wires 812and 822 are coupled with the operation knob.

When the operation unit 106 is operated to pull the wire 822, thesupport member 750 is moved in the forward direction with respect to theguide 770. As a result, the support member 730 and the cutters 710 and720 are integrally moved in the forward direction. Additionally, whenthe operation unit 106 is operated to pull the wire 812, the supportmember 750 is moved in the backward direction with respect to the guide770. As a result, the support member 730 and the cutters 710 and 720 areintegrally moved in the backward direction.

The wire assemblies 830 and 840 are to move the support member 730 inthe forward-and-backward directions with respect to the support member750. The wire assembly 830 includes a wire 832 fixed to the pin 734 ofthe support member 730 and a wire outer tube 834 fixed to a rear portionof the support member 750. Further, the wire assembly 840 includes awire 842 fixed to the pin 734 of the support member 730 and a wire outertube 844 fixed to a front portion of the support member 750. The wireassemblies 830 and 840 extend to the operation unit 106 through theconnecting rod 104, and the wires 832 and 842 are coupled with theoperation knob.

When the operation unit 106 is operated to pull the wire 842, thesupport member 730 is moved in the forward direction with respect to thesupport member 750. As a result, the pins 792 and 794 are moved in theupward direction, the cutter 710 is moved in the upward direction, thepins 796 and 798 are moved in the downward direction, and the cutter 720is moved in the downward direction. Moreover, when the operation unit106 is operated to pull the wire 832, the support member 730 is moved inthe backward direction with respect to the support member 750. As aresult, the pins 792 and 794 are moved in the downward direction, thecutter 710 is moved in the downward direction, the pins 796 and 798 aremoved in the upward direction, and the cutter 720 is moved in the upwarddirection.

The wire assemblies 850 and 860 are to move the cutter 710 in theforward-and-backward directions with respect to the support member 730.The wire assembly 850 includes a wire 852 fixed to a rear portion of thesupport portion 716 of the cutter 710 and a wire outer tuber 854 fixedto the pin 794. Additionally, the wire assembly 860 includes a wire 862fixed to the arm 714 of the cutter 710 and a wire outer tube 864 fixedto the pin 792. The wire assemblies 850 and 860 extend to the operationunit 106 through the connecting rod 104, and the wires 852 and 862 arecoupled with the operation knob.

When the operation unit 106 is operated to pull the wire 852, the cutter710 is moved in the forward direction with respect to the support member730. Further, when the operation unit 106 is operated to pulled the wire862, the support member 750 is moved in the backward direction withrespect to the cutter 710.

Likewise, the wire assemblies 870 and 880 are to move the cutter 720 inthe forward-and-backward directions with respect to the support member730. The wire assembly 870 includes a wire 872 fixed to the rear portionof the support portion 726 of the cutter 720 and a wire outer tube 874fixed to the pin 798. Furthermore, the wire assembly 880 includes a wire882 fixed to the arm 724 of the cutter 720 and a wire outer tube 884fixed to the pin 796. The wire assemblies 870 and 880 extend to theoperation unit 106 through the connecting rod 104, and the wires 872 and882 are coupled with the operation knob.

When the operation unit 106 is operated to pull the wire 872, the cutter720 is moved in the forward direction with respect to the support member730. Further, when the operation unit 106 is operated to pull the wire882, the support member 750 is moved in the backward direction withrespect to the cutter 720.

As explained above, in the incision mechanism 700, the cutter 710 andthe cutter 720 can be independently operated in the upward-and-downwarddirections and the forward-and-backward directions.

As shown in FIGS. 4 to 6, the staple holder 200, the coronary-arterysupport mechanism 300, the graft support mechanism 400, the innerpillars 532, the outer pillars 612, the inner pillars 632, and theincision mechanism 700 are all mounted in the frame 110.

As shown in FIG. 6, the frame 110 has four pairs of side wall portions112, 114, 116, and 118 extending upward in parallel to each other onlateral both sides, and also has one rear end wall portion 120 extendingupward at a rear end portion. The side wall portions 112 and 118 havethe same height. The side wall portions 114 and 116 have the sameheight. The height of the side wall portions 114 and 116 is larger thanthe height of the side wall portions 112 and 118. The side wall portions112 and 118 have grooves 122 and 128 extending in theupward-and-downward directions, respectively. The grooves 122 and 128have the same length. The side wall portions 114 and 116 have grooves124 and 126 extending in the upward-and-downward directions,respectively. The grooves 124 and 126 have the same length. The sidewall portions 114 have a pair of pins 132 protruding laterally at upperportions of the grooves 124. Furthermore, the side wall portions 116have a pair of pins 134 protruding laterally at upper portions of thegrooves 126.

The base portion 416 of the graft support mechanism 400 has a grooveextending in the forward-and-backward directions, and both side portionsof this groove extend on lateral both sides of the plate-like portions752 of the support member 750 of the incision mechanism 700. The basemember 220 of the staple holder 200 has a groove extending in theforward-and-backward directions, and both side portions of this grooveextend on lateral both sides of the plate-like portions 752 of thesupport member 750 of the incision mechanism 700. The outer pillars 512and the inner pillars 532 extend on lateral both sides of the plate-likeportions 752 of the support member 750 of the incision mechanism 700.Likewise, the outer pillars 612 and the inner pillars 632 extend onlateral both sides of the plate-like portions 752 of the support member750 of the incision mechanism 700.

As explained above, the front fixing portion 772 of the guide 770 of theincision mechanism 700 has the pair of pins 782 protruding laterally,and the rear fixing portion 774 has the pair of pins 784 protrudinglaterally. The pins 782 of the front fixing portion 772 run through thegrooves 124 of the side wall portions 114 of the frame 110, and the pins784 of the rear fixing portion 774 run through the grooves 126 of theside wall portions 116 of the frame 110. Further, the base portion 416of the graft support mechanism 400 has two pairs of pins 432 and 434protruding laterally. The pins 432 run through the grooves 124 of theside wall portions 114 of the frame 110, and the pins 434 run throughthe grooves 126 of the side wall portions 116 of the frame 110.Furthermore, the base member 220 of the staple holder 200 has two pairsof pins 222 and 224 protruding laterally. The pins 222 run through thegrooves 124 of the side wall portions 114 of the frame 110, and the pins224 run through the grooves 126 of the side wall portions 116 of theframe 110.

The inner pillars 632 have two pairs of pins 642 and 644 protrudinglaterally. The pins 642 run through the grooves 122 of the side wallportions 112 of the frame 110, and the pins 644 run through the grooves128 of the side wall portions 118 of the frame 110. Moreover, the outerpillars 612 have two pairs of pins 622 and 624 protruding laterally. Thepins 622 run through the grooves 122 of the side wall portions 112 ofthe frame 110, and the pins 624 run through the grooves 128 of the sidewall portions 118 of the frame 110. Additionally, the outer pillars 512have two pairs of pins 522 and 524 protruding laterally. The pins 522run through the grooves 122 of the side wall portions 112 of the frame110, and the pins 524 run through the grooves 128 of the side wallportions 118 of the frame 110. Further, the inner pillars 532 have twopairs of pins 542 and 544 protruding laterally. The pins 542 run throughthe grooves 122 of the side wall portions 112 of the frame 110, and thepins 544 run through the grooves 128 of the side wall portions 118 ofthe frame 110.

As shown in FIG. 5, an inner slider 140 is disposed to the frame 110 tobe movable in the forward-and-backward directions with respect to theframe 110. The inner slider 140 is formed of a plate material that isbent in a substantially U-like shape as viewed from above, and has sidewall portions that are parallel to each other on lateral both sides.

The inner slider 140 has a pair of side wall portions, each of which hasgrooves 152, 154, 156, and 158 in a forward part and grooves 162, 164,166, and 168 in a backward part. The grooves 152, 154, 156, and 158 havethe same shapes as the grooves 162, 164, 166, and 168. The grooves 152and 162 entirely linearly extend in the forward-and-backward directions.Each of the grooves 154 and 164 has a forward part linearly extending inthe forward-and-backward directions and a backward part obliquelylinearly extending with respect to the forward-and-backward directions.The backward part of each of the grooves 154 and 164 is upwardlyinclined in the backward direction. Each of the grooves 156 and 166 hasa forward part and a backward part, both of which linearly extend withinclined with respect to the forward-and-backward directions. Both theforward part and the backward part of each of the grooves 156 and 166are upwardly inclined in the backward direction. Each of the grooves 158and 168 has a forward part and a backward part, both of which linearlyextend with inclined with respect to the forward-and-backwarddirections. Both the forward part and the backward part of each of thegrooves 158 and 168 are likewise upwardly inclined in the backwarddirection, and inclination of the backward part is larger than that ofthe forward part.

The pins 542 and 544 of the inner pillars 532 protruding through thegrooves 122 and 128 of the side wall portions 112 and 118 of the frame110 are inserted in the grooves 152 and 162, respectively. The pins 522and 524 of the outer pillars 512 protruding through the grooves 122 and128 of the side wall portions 112 and 118 of the frame 110 are insertedin the grooves 154 and 164, respectively. The pins 622 and 624 of theouter pillars 612 protruding through the groves 122 and 128 of the sidewall portions 112 and 118 of the frame 110 are inserted in the grooves156 and 166, respectively. The pins 642 and 644 of the inner pillars 632protruding through the grooves 122 and 128 of the side wall portions 112and 118 of the frame 110 are inserted in the grooves 158 and 168,respectively.

Further, each side wall portion of the inner slider 140 has a groove 142at the back of the grooves 152, 154, 156, and 158 and a groove 144 infront of the grooves 162, 164, 166, and 168. The groove 142 and thegroove 144 have the same shape. Each of the grooves 142 and 144 has aforward part and a backward part, both of which linearly extend withinclined with respect to the forward-and-backward directions. Both theforward part and the backward part of each of the grooves 42 and 144 areupwardly inclined in the backward direction, and inclination of thebackward part is larger than that of the forward part.

The pins 222 and 224 of the staple holder 200 protruding through thegrooves 124 and 126 of the side wall portions 114 and 116 of the frame110 are inserted in the grooves 142 and 144, respectively.

With such a groove cam mechanism, backward movement of the inner slider140 with respect to the frame 110 causes the outer pillars 512, thestaple holder 200, the outer pillars 612, the inner pillars 632, and theinner pillars 532 to move closer to each other, so that a relative gapof these members in the upward-and-downward directions is narrowed.Contrarily, forward movement of the inner slider 140 with respect to theframe 110 causes the outer pillars 512, the staple holder 200, the outerpillars 612, the inner pillars 632, and the inner pillars 532 to moveaway from each other, so that the relative gap of these members in theupward-and-downward directions is widened.

Wire assemblies 550 and 560 to move the inner slider 140 in theforward-and-backward directions with respect to the frame 110 areprovided. The wire assembly 550 includes a wire 552 fixed to the pin 544and a wire outer tube 554 fixed at a rear end portion of the innerslider 140. Furthermore, the wire assembly 560 includes a wire 562 fixedat the rear end portion of the inner slider 140 and a wire outer tube564 fixed at the rear end wall portion 120 of the frame 110. The wireassemblies 550 and 560 extend to the operation unit 106 through theconnecting rod 104, and the wires 552 and 562 are coupled with theoperation knob.

When the operation unit 106 is operated to pull the wire 562, the innerslider 140 is moved in the backward direction with respect to the frame110. Consequently, as explained above, the relative gap of the innerpillars 532, the outer pillars 512, the staple holder 200, the outerpillars 612, and the inner pillars 632 is narrowed. Furthermore, whenthe operation unit 106 is operated to pull the wire 552, the innerslider 140 is moved in the forward direction with respect to the frame110. Consequently, as explained above, the relative gap of the innerpillars 532, the outer pillars 512, the staple holder 200, the outerpillars 612, and the inner pillars 632 is widened.

As will be described later in detail, when the inner pillars 532, theouter pillars 512, the outer pillars 612, and the inner pillars 632 aremoved away from the staple holder 200 from a state where they are closeto the staple holder 200, the staple pins 14 of the staples 10 held inthe staple holder 200 are stretched substantially straight from the bentstate. Moreover, when the inner pillars 532, the outer pillars 512, theouter pillars 612, and the inner pillars 632 are moved closer to thestaple holder 200 from the state where they are apart from the stapleholder 200, the staple pins 14 of the staple 10 are restored to thenaturally bent state from the straightened state. That is, the innerpillars 532, the outer pillars 512, the outer pillars 612, the innerpillars 632, and the mechanism to move these members in theupward-and-downward directions constitute a curvature control mechanismto control curvature of the staple pins 14 of the staple 10.

As shown in FIG. 4, an outer slider 170 is disposed to the frame 110 tobe movable in the forward-and-backward directions with respect to theframe 110. The outer slider 170 is formed of a plate material that isbent in a substantially-U-like shape, and has side wall portions thatare parallel to each other on lateral both sides.

The outer slider 170 has a pair of side wall portions, each of which hasgrooves 172, 174, 176, and 178 in a forward part and grooves 182, 184,186, and 188 in a backward part. The grooves 172, 174, 176, and 178 havethe same shapes as the grooves 182, 184, 186, and 188, respectively.Each of the grooves 172 and 178 has a forward part, a central part, anda backward part, which linearly extend with inclined in theforward-and-backward directions. The forward part, the central part, andthe backward part of each of the grooves 172 and 182 are all inclinedupward in the backward direction. Each of the grooves 174 and 184 alsohas a forward part, a central part, and a backward part, which linearlyextend with inclined in the forward-and-backward directions. The forwardpart, the central part, and the backward part of each of the grooves 174and 184 are all inclined upward in the backward direction. Each of thegrooves 176 and 186 has a forward part and a central part, whichlinearly extend in the forward-and-backward directions, and a backwardpart, which linearly extends with inclined in the forward-and-backwarddirections. The backward part of each of the grooves 176 and 186 isinclined upward in the backward direction. The grooves 178 and 188entirely linearly extend in the forward-and-backward directions.

The pins 222 and 224 of the staple holder 200 protruding through thegrooves 124 and 126 in the side wall portions 114 and 116 of the frame110 are inserted in the grooves 172 and 182, respectively. The pins 432and 434 of the graft support mechanism 400 protruding through thegrooves 124 and 126 in the side wall portions 114 and 116 of the frame110 are inserted in the grooves 174 and 184, respectively. The pins 782and 784 of the incision mechanism 700 protruding through the grooves 124and 126 in the side wall portions 114 and 116 of the frame 110 areinserted in the grooves 176 and 186, respectively. The pins 132 and 134of the frame 110 are inserted in the grooves 178 and 188, respectively.

When such a groove cam mechanism is adopted, backward movement of theouter slider 170 with respect to the frame 110 causes the staple holder200 and the graft support mechanism 400 to move downward to get closerto the coronary-artery support mechanism 300, so that the relative gapof these members in the upward-and-downward directions is narrowed.Meanwhile, the incision mechanism 700 is moved downward only while therelative gap of the staple holder 200, the graft support mechanism 400,and the coronary-artery support mechanism 300 is large, and maintainedthis height after that. Contrarily, forward movement of the outer slider170 with respect to the frame 110 causes the staple holder 200 and thegraft support mechanism 400 to move upward to get away from thecoronary-artery support mechanism 300, so that the relative gap of thesemembers in the upward-and-downward directions is widened. Meanwhile theincision mechanism 700 is moved upward only while the relative gap ofthe staple holder 200, the graft support mechanism 400, and thecoronary-artery support mechanism 300 is large, and maintained thisheight after that.

Wire assemblies 350 and 360 to move the outer slider 170 in theforward-and-backward directions with respect to the frame 110 areprovided. The wire assembly 350 includes a wire 352 fixed at the rearend portion of the outer slider 170 and a wire outer tube 354 fixed atthe rear end wall portion 120 of the frame 110. Additionally, the wireassembly 360 includes a wire 362 fixed at the pin 134 of each side wallportion 116 of the frame 110 and a wire outer tube 364 fixed at the rearend portion of the outer slider 170. The wire assemblies 350 and 360extend to the operation unit 106 through the connecting rod 104, and thewires 352 and 362 are coupled with the operation knob.

When the operation unit 106 is operated to pull the wire 352, the innerslider 140 is moved in the backward direction with respect to the frame110. Consequently, as described above, the relative gap of the stapleholder 200, the graft support mechanism 400, and the coronary-arterysupport mechanism 300 is narrowed. Further, when the operation unit 106is operated to pull the wire 362, the inner slider 140 is moved forwardwith respect to the frame 110. Consequently, as explained above, therelative gap of the staple holder 200, the graft support mechanism 400,and the coronary-artery support mechanism 300 is widened.

The staple holder 200, the graft support mechanism 400, and themechanism to move these members constitute a gap control mechanism tocontrol gaps of two hollow tissues, i.e., the coronary artery and thegraft, with respect to the staple holder 200.

This gap control mechanism to control gaps of the coronary artery andthe graft is driven when the outer slider 170 is moved in theforward-and-backward directions with respect to the frame 110. Further,the curvature control mechanism to control curvature of the staple pins14 of the staple 10 is driven when the inner slider 140 is moved in theforward-and-backward directions with respect to the frame 110. That is,the gap control mechanism and the curvature control mechanism areindependent from each other.

The graft support mechanism 400 will now be described in detail withreference to FIGS. 9 to 14.

As shown in FIG. 9, a leaf spring 422 is disposed to the fixing portion414 and the base portion 416. The leaf spring 422 urges the fixingportion 414 to become straight with respect to the base portion 416,i.e., urges the fixing portion 414 to eliminate its inclination withrespect to the base portion 416. Further, as shown in FIG. 10, a throughhole is formed in the base portion 416, and a pin 420 is accommodated inthis through hole. The pin 420 can move forward/backward in the throughhole of the base portion 416. A coil spring 424 is incorporated in thethrough hole of the base portion 416. The coil spring 424 urges the pin420 to protrude from the base portion 416. A wire 426 is connected withthe pin 420. The wire 426 extends to the operation unit 106 through theconnecting rod 104 to be coupled with the operation knob.

In a state depicted in FIGS. 9 and 10, the fixing portion 414 urged bythe leaf spring 422 is contact with the pin 420 protruding from the baseportion 416. As a result, the fixing portion 414 is locked in a posturein which the fixing portion 414 is inclined with respect to the baseportion 416. In this specification, this state is called an openedstate. When the wire 426 is pulled from this opened state againstelastic force of the coil spring 424, the pin 420 is pulled into thebase portion 416, so that the fixing portion 414 is unlocked as shown inFIG. 11. The fixing portion 414 swivels on the shaft 418 by utilizing onforce received from the leaf spring 422. Swiveling of the fixing portion414 is stopped when an end face of the fixing portion 414 comes intocontact with the base portion 416. As a result, the fixing portion 414gets still in a posture in which the fixing portion 414 linearly extendswith respect to the base portion 416 as shown in FIG. 12. Then, when thewire 426 is loosened, the pin 420 protrudes from the base portion 416based on elastic force of the coil spring 424 and enters the hole of thefixing portion 414. As a result, the fixing portion 414 is locked in aposture in which the fixing portion 414 linearly extends with respect tothe base portion 416. In this specification, this state is called aclosed state.

Basically, the coronary-artery support mechanism 300 also has the samestructure as the graft support mechanism 400. That is, in thecoronary-artery support mechanism 300, when the fixing portion 314 urgedby a leaf spring is contact with a pin 320 protruding from the baseportion 316, the fixing portion 314 is locked in a posture in which thefixing portion 314 is inclined with respect to the base portion 316.That is, the coronary-artery support mechanism 300 is in the openedstate. When the pin 320 is drawn into the base portion 316 from thisstate, so that the fixing portion 314 is unlocked, the fixing portion314 swivels on the shaft 318 and gets still in a posture in which thefixing portion 314 linearly extends to the base portion 316. Then, thepin 320 protrudes from the base portion 316 to enter the hole of thefixing portion 314, causing the fixing portion 314 to be locked in aposture in which the fixing portion 314 linearly extends with respect tothe base portion. That is, the coronary-artery support mechanism 300enters the closed state.

As one of differences between the graft support mechanism 400 and thecoronary-artery support mechanism 300, since the graft supports 412 ofthe graft support mechanism 400 are inserted into the graft from its endface, the graft supports 412 are straight, whereas since thecoronary-artery supports 312 of the coronary-artery support mechanism300 are stuck into the coronary artery from a side surface of thecoronary artery, root portions of the coronary-artery supports 312 arebent downward, and portions of the coronary-artery supports 312 that areactually inserted into the coronary artery deviate from a position fixedto the fixing portion 314 in the downward direction.

Furthermore, as another difference from the coronary-artery supportmechanism 300, the graft support mechanism 400 has a graft holdingmechanism to hold the graft. Therefore, as shown in FIG. 14, a tube 442through which a gas is supplied is connected with the fixing portion414. For example, a suction hole that is opened in a surface contactingwith the graft is provided in the fixing portion 414. The suction holeis connected with a negative-pressure source through the tube 442. Inthis configuration, a pressure in the tube 442 is reduced by thenegative-pressure source, causing the graft to be adsorbed to the fixingportion 414, so that the graft is held by the fixing portion 414. Asanother example, a balloon 444 is disposed to the fixing portion. Theballoon 444 is connected with a gas supply source through the tube 442.In this configuration, a gas is supplied to the balloon 444 from the gassupply source, inflating the balloon in the graft, so that the graft isheld by the fixing portion 414.

An operation of inosculating the coronary artery and the graft with thestaple 10 by using the hollow tissue inosculation apparatus 100 will nowbe described with reference to FIGS. 15 to 51.

As shown in FIG. 15, the hollow tissue inosculation apparatus 100 isadjusted to a state where the coronary-artery support mechanism 300 andthe graft support mechanism 400 are opened. Moreover, the outer pillars512, the inner pillars 532, the outer pillars 612, and the inner pillars632 are moved closer to the staple holder 200 in advance. The staple 10is arranged in front of the staple holder 200 so that the ring member 12is aligned in the grooves 212 of the staple holding members 210.

Then, the ring member 12 is pushed into a space between the grooves 212of the staple holding members 210 to attach the staple 10 to the stapleholder 200. At this time, the ring member 12 is slid along the grooves212 of the staple holding members 210 while being squashed. As a result,the staple 10 is deformed into the deformed state depicted in FIG. 2from the natural state shown in FIG. 1. Additionally, the outer pillars512, the inner pillars 532, the outer pillars 612, and the inner pillars632 are moved away from the staple holder 200 to straighten the staplepins 14 of the staple 10. FIGS. 16 and 17 show a state where the staple10 is inserted into the staple holder 200 and the staple pins 14 arestraightened.

Subsequently, as shown in FIGS. 18 and 19, the coronary-artery supports312 are stuck into a coronary artery 50 and the coronary-artery supportmechanism 300 is then closed, and the graft supports 412 and the fixingportion 414 are inserted into a graft 60 from its end face. Further, thegraft holding mechanism is used to hold the graft 60 on the fixingportion 414.

Then, as shown in FIGS. 20 to 22, the graft support mechanism 400 isclosed. As a result, the coronary artery 50 and the graft 60 arearranged in substantially parallel to each other.

Subsequently, as shown in FIGS. 23 to 25, the graft support mechanism400 and the staple holder 200 are moved closer to the coronary-arterysupport mechanism 300 to narrow gaps of the graft support mechanism 400and the coronary-artery support mechanism 300 with respect to the stapleholder 200, so that end portions of the staple pins 14 of the staple 10are stuck into the coronary artery 50 and the graft 60. Thecoronary-artery supports 312 and the graft supports 412 respectivelysupport the coronary artery 50 and the graft 60 when the staple pins 14of the staple 10 are stuck into the coronary artery 50 and the graft 60.Stick of the staple pins 14 is moderately performed so that the staplepins 14 do not penetrate the coronary artery 50 and the graft 60.

Subsequently, as shown in FIGS. 26 to 28, the cutters 710 and 720 of theincision mechanism 700 are moved in the forward direction to arrange theblades 712 and 722 at the back of the inside of the ring member 12 ofthe staple 10. In FIGS. 26 and 27, the outer pillars 612 and the innerpillars 632 are omitted to facilitate visualization of the cutter 710.

Then, the cutter 710 is moved in the downward direction to cause theblade 712 to stick through the coronary artery 50, and the cutter 720 ismoved in the upward direction to cause the blade 722 to stick throughthe graft 60. Thereafter, both the cutter 710 and the cutter 720 aremoved in the forward direction to incise the coronary artery 50 and thegraft 60, respectively. FIGS. 29 to 31 show a state when incision isfinished.

Although FIGS. 26 to 28 show an example of incising the coronary artery50 and the graft 60 at the same position for the same length, but theposition and the length for incision of the coronary artery 50 may bedifferent from those of the graft 60. That is, the coronary artery 50and the graft 60 may be incised at the same position for differentlengths, or they may be incised at different positions for the samelength or at different positions for different lengths.

As explained above, according to the incision mechanism 700, the blades712 and 722 of the cutters 710 and 720 are arranged between the coronaryartery 50 and the graft 60 to incise the coronary artery 50 and thegraft 60 from the outer side. Further, the staple holder 200 holds thestaple 10 in such a manner that the blades 712 and 722 of the cutters710 and 720 do not come into contact with the staple 10. Specifically,the staple holder 200 holds the staple 10 so that the blades 712 and 722of the cutters 710 and 720 are placed at the inside of the ring member12. Further, the staple holder 200 functions as an expansion preventingmechanism to prevent the ring member 12 of the staple 10 from expandingwhile the staple 10 is held or while at least the coronary artery 50 andthe graft 60 are incised.

Then, the cutter 710 is moved in the upward direction to pull out theblade 712 from the coronary artery 50, and the cutter 720 is moved inthe downward direction to pull out the blade 722 from the graft 60.Thereafter, both the cutters 710 and 720 are moved in the backwarddirection to be retracted into the housing 190. FIGS. 32 to 34 show astate while the cutters 710 and 720 are retracted. In FIGS. 32 and 33,the outer pillars 612 and the inner pillars 632 are omitted tofacilitate visualization of the cutter 710.

In the hollow tissue inosculation apparatus 100 according to thisembodiment, the four wires 852, 862, 872, and 882 connected with theincision mechanism 700 are coupled with different operation knobs of theoperation unit 106, respectively. Alternatively, the two wires 852 and872 are coupled with a common operation knob so that directions of theiroperations are opposite to each other, and the two wires 862 and 882 arecoupled with another common operation knob so that directions of theiroperations are opposite to each other. The operation knob coupled withthe wires 852 and 862 and the operation knob coupled with the wires 872and 882 may be individually operated, enabling the coronary artery 50and the graft 60 to be incised at different positions or for differentlengths, or at different positions for different lengths.

Furthermore, if the hollow tissue inosculation apparatus 100 is alwaysused for a purpose of incising the coronary artery 50 and the graft 60at the same position for different lengths, the two wires 852 and 872may be coupled with a common operation knob of the operation unit 106and the two wires 862 and 882 may be coupled with another commonoperation knob of the operation unit 106 in the hollow tissueinosculation apparatus 100. Alternatively, the pair of wires 852 and 872and the pair of wires 862 and 882 may be coupled with a common operationknob in such a manner that directions of operations of the respectivepairs are opposite to each other.

Then, as shown in FIGS. 35 to 37, the graft support mechanism 400 andthe staple holder 200 are further moved closer to the coronary-arterysupport mechanism 300 to narrow gaps of the graft support mechanism 400and the coronary-artery support mechanism 300 with respect to the stapleholder 200. At this time, the inner pillars 632 and the inner pillars532 move closer to the staple holder 200 in cooperation with the graftsupport mechanism 400 and the coronary-artery support mechanism 300, butboth the outer pillars 612 and the outer pillars 512 do not move withrespect to the staple holder 200. The graft support mechanism 400 andthe coronary-artery support mechanism 300 are moved closer to the stapleholder 200 in this manner, causing the end portions of the staple pins14 of the staple 10 to penetrate through the coronary artery 50 and thegraft 60. Meanwhile, the coronary-artery supports 312 and the graftsupports 412 support the coronary artery 50 and the graft 60,respectively. Furthermore, contact positions of the coronary-arterysupports 312 and the graft supports 412 to the coronary artery 50 andthe graft 60 deviate from positions at which the staple pins 14 of thestaple 10 penetrate through the coronary artery 50 and the graft 60.FIGS. 38 to 40 show a state where the end portions of the staple pins 14of the staple 10 penetrate through the coronary artery 50 and the graft60, respectively.

As shown in FIG. 40, the coronary-artery supports 312 and the graftsupports 412 are positioned at the inner side of the end portions of thestaple pins 14 having penetrated through the coronary artery 50 or thegraft 60. Therefore, the end portions of the staple pins 14 havingpenetrated the coronary artery 50 or the graft 60 are to be restored tothe bent state as the natural state, but they come into contact with thecoronary-artery supports 312 and the graft supports 412, and thecoronary-artery supports 312 and the graft supports 412 obstructdeformation for restoration to the original bent state. That is, in thisembodiment, the coronary-artery supports 312 and the graft supports 412function as suppression members to suppress deformation of the staplepins 14 to the original bent shape thereof, i.e., restoration of thestaple pins 14.

Then, as shown in FIGS. 41 to 43, the graft support mechanism 400 andthe staple holder 200 are moved away from the coronary-artery supportmechanism 300 to widen the gaps of the graft support mechanism 400 andthe coronary-artery support mechanism 300 with respect to the stapleholder 200, releasing contact between the end portions of the staplepins 14 having penetrated the coronary artery 50 and the coronary-arterysupports 312 and contact between the end portions of the staple pins 14having penetrated the graft 60 and the graft supports 412. As a result,the end portions of the staple pins 14 having penetrated through thecoronary artery 50 and the end portions of the staple pins 14 havingpenetrated through the graft 60 return to the original bent shape. Withthis deformation of the end portions of the staple pins 14, a partaround an incised position of the coronary artery 50 is pulled upward,and a part around an incised position of the graft 60 is pulleddownward. As a result, a section of the coronary artery 50 faces asection of the graft 60.

Subsequently, as shown in FIGS. 44 to 46, the outer pillars 512, theinner pillars 532, the outer pillars 612, and the inner pillars 632 aremoved closer to the staple holder 200. Consequently, as shown in FIGS.46, the section of the coronary artery 50 comes into contact with thesection of the graft 60, and each staple pin 14 is restored to itsoriginal bent shape.

Thereafter, as shown in FIGS. 47 and 48, the staple holder 200, thecoronary-artery supports 312, the graft supports 412, and others areremoved from the staple 10 that has inosculated the coronary artery 50to the graft 60. As a result, the staple 10 comes off the staple holder200, and the ring member 12 is restored to its original expanded shape.Consequently, the contact portion of the coronary artery 50 and thegraft 60 spreads to the outside, and a flow path is assured between thecoronary artery 50 and the graft 60. FIGS. 49 to 51 show the coronaryartery 50 and the graft 60 that are inosculated to each other.

This embodiment has the following advantages.

Since the blades 712 and 722 of the cutters 710 and 720 are arrangedbetween the coronary artery 50 and the graft 60 to incise the coronaryartery 50 and the graft 60 from the outside, the hollow tissueinosculation apparatus 100 can be used for the narrow coronary artery 50and graft 60.

Further, since the cutter 710 and the cutter 720 in the incisionmechanism 700 can be independently operated in the upward-and-downwarddirections and the forward-and-backward directions, the coronary artery50 and the graft 60 can be incised at positions that are equal to ordifferent from each other for lengths that are equal to or differentfrom each others. As a result, the coronary artery 50 and the graft 60having different blood vessel wall thicknesses can be appropriatelyinosculated to each other.

Since the staple holder 200 holds the staple 10 in such a manner thatthe blades 712 and 722 of the cutters 710 and 720 do not come intocontact with the staple 10, foreign particles can be prevented frombeing generated due to collision of the blades 712 and 722 of thecutters 710 and 720 and the staple 10. The foreign particles generateddue to collision of the blades 712 and 722 of the cutters 710 and 720and the staple 10 do not enter blood vessels.

Since the staple holder 200 prevents the ring member 12 of the staple 10from being expanded, a load applied to the blood vessels when incisingthe coronary artery 50 and the graft 60 is small.

Since the coronary-artery supports 312 and the graft supports 412deviate from the position where the staple pins 14 of the staple 10penetrate through the coronary artery 50 and the graft 60, a loadapplied to the blood vessels when penetrating the staple pins 14 of thestaple 10 through the coronary artery 50 and the graft 60 is small.

The section of the coronary artery 50 is brought into contact with thesection of the graft 60 to inosculate the coronary artery 50 to thegraft 60, and hence cell proliferation due to the self-reparativefunction hardly occurs, thereby reducing block of a blood flow owing tocell proliferation.

[Modification of Stapler]

A modification of the staple will now be described. In theabove-described embodiment, the ring member 12 in the staple 10 has aclosed ring-like shape, but the shape of the ring member 12 is notrestricted thereto. As a modification of the staple 10, FIG. 52 showsanother staple 10A that can be used in place of the staple 10 depictedin FIGS. 1 and 2. As shown in FIG. 52, in a staple 10A according to thismodification, a ring member 12A has an opened ring-like shape. Otherstructures are the same as those of the staple 10 depicted in FIGS. 1and 2. This staple 10A is used in the hollow tissue inosculationapparatus 100 in completely the same manner as the staple 10 depicted inFIGS. 1 and 2.

Although the embodiment according to the present invention has beendescribed with reference to the accompanying drawings, the presentinvention is not restricted thereto, and various modifications orchanges can be carried out without departing from the scope of theinvention.

The mechanism to move the staple holder 200, the graft support mechanism400, the outer pillars 512, the inner pillars 532, the outer pillars612, and the inner pillars 632 in the upward-and-downward directions isformed of the groove cam mechanism in the foregoing embodiment, but thepresent invention is not restricted thereto. This mechanism may beconstituted of a mechanism that utilizes a translation link, anoscillation link, screws, gears, and others. Likewise, the mechanism tomove the cutters 710 and 720 is not restricted to the groove cammechanism, and it may be constituted of a mechanism that utilizes atranslation link, an oscillation link, screws, gears, and others. Thesemechanisms are operated by the wires in the embodiment, but the presentinvention is not restricted thereto, and the mechanisms may be operatedby an arbitrary force transmission member such as a multi-node link. Inplace of using the force transmission member, an actuator may beprovided to these mechanisms and used to operate them.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details and representative embodiments shownand described herein. Accordingly, various modifications may be madewithout departing from the spirit or scope of the general inventiveconcept as defined by the appended claims and their equivalents.

1. A hollow tissue inosculation apparatus to inosculate two hollowtissues to each other with a staple having a plurality of elasticallydeformable bent staple pins, comprising: a staple holder to hold thestaple; a curvature control mechanism to control curvature of the staplepins of the staple held in the staple holder, the curvature controlmechanism substantially straightening the staple pins; and a gap controlmechanism to control gaps of the hollow tissues with respect to thestaple holder, the gap control mechanism reducing the gaps to cause thesubstantially straightened staple pins to penetrate the hollow tissues,the curvature control mechanism and the gap control mechanism beingindependent from each other; wherein the gap control mechanism includestwo hollow tissue support mechanisms to support the two hollow tissues,respectively, and a mechanism to move the two hollow tissue supportmechanisms in such a direction as to get closer to each other and insuch a direction as to get away from each other.
 2. The apparatusaccording to claim 1, wherein the hollow tissue support mechanisms havesuppression members to suppress restoration of the staple pins.
 3. Theapparatus according to claim 1, further comprising an incision mechanismto incise the hollow tissues.